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individual appointment, or other means be adopted to reduce to a minimum
the time during which patients are kept waiting at the Dispensary.
It is not possible, I am informed (at least for the present), to carry
out an arrangement by which patients could be seen by individual appointment.
The number of patients attending, the variation in the times taken
in the examination of cases, and the attendance of old or casual patients,
makes it difficult to adopt a system of individual appointments. As far as
practicable, efforts are made to prevent patients being kept waiting an
undue length of time, and I am informed that no patient is kept waiting
longer than two hours.
Recommendation 10.—More adequate arrangements than at present
should be made for the examination by the Tuberculosis Officer of the
home “contacts” of newly notified cases, and for the “following up” of
patients for whose failure to continue attendance at the Dispensary no
satisfactory reason has been obtained.
This recommendation relates to one of the most essential functions of a
Tuberculosis Dispensary Scheme, embracing as it does a two-fold object:
(i.) the examination of “contacts,” viz., persons living with or closely associated
with, an active case of Tuberculosis, and (ii.) the “following up” of
patients ceasing to attend the Dispensary without satisfactory reasons being
obtained. With regard to both these important functions of a Dispensary
organisation, there is in Battersea, as elsewhere, no doubt, room for improvement,
and the transfer of the Tuberculosis Dispensary to the control of the
Borough Council as a branch of their Public Health service, thus bringing
the Dispensary into closer co-operation with the Council's Public Health
work, must necessarily be followed by increased activity and efficiency in
this direction. In order to obtain the best results, it is essential that the
Dispensary Staff (Medical and Nursing) shall be adequate and efficient.
More especially is it important that the Nursing Staff is sufficient, as it is
largely by means of the home visits of the Dispensary Nurses that
“contacts” are induced to attend the Dispensary for examination. The
equally important duty of “following up” of undischarged patients to secure
a re-continuance of their attendance at the Dispensary is also largely dependent
on the activity and efficiency of the nursing and sanitary (Public
Health Department) staffs.
Recognising this, the Council have already agreed to an increase in
the Nursing Staff, and one additional Nurse has, with the approval of the
Ministry of Health, been appointed. It will, in my opinion, be found that,
if any considerable improvement is to be effected in regard to these important
functions of a Tuberculosis Dispensary Scheme, at least one more
Nurse will be required.
It will probably be necessary, in the light of more extended experi
ence of the revised Dispensary Scheme for Tuberculosis, to return to the
question of “contacts” and “following up” in relation to future revision of
the Tuberculosis scheme, as, in the opinion of most Tuberculosis experts,
the importance of this aspect of preventive activity in relation to Tuberculosis
Dispensary Schemes cannot be overestimated.
Recommendation 11.—It is important that the Tuberculosis Officer should
become personally acquainted as far as possible with all medical practitioners
practising in the area served by the Dispensary, in order that the fullest
degree cf co-operation may be secured.
The Tuberculosis Officer is alive to the advantages of close and cordial
co-operation with the local doctors, as set out in this recommendation, and
the suggestions of the Ministry in this respect are being fully carried out
in Battersea.
Recommendation 12.—The local arrangements should be such as will
enable the Tuberculosis Officer to visit the homes of Dispensary patients